Diabetes and diastolic function: stiffness and relaxation from transmitral flow.

To characterize the mechanism by which diabetes affects the heart in diabetic (n = 15) and age-matched control subjects (n = 15), we quantified and compared diastolic function (DF) in terms of chamber stiffness and viscosity/relaxation by analyzing Doppler E- and E'-waves and simultaneous (high-fidelity) hemodynamic data. We compared tau, standard Doppler indexes and indexes of stiffness and viscosity/relaxation computed via the parameterized diastolic filling (PDF) formalism. Three PDF parameters uniquely characterize each E-wave in terms of load (x(o)), viscoelasticity or viscosity/relaxation (c) and stiffness (k). Significant differences for c (p = 0.00004), the peak atrioventricular pressure gradient (kx(o)) (p = 0.02) and the stored elastic energy available for early filling (1/2kx(o)2) (p = 0.04) were found. The only conventional index attaining significance was E-wave acceleration time (p = 0.007). Neither time constant of isovolumic relaxation (tau) nor E-wave deceleration time, E', k or x(o) differentiated between groups. We conclude that PDF based DF assessment differentiates between diabetic and nondiabetic controls better than conventional echo- or cath-based indexes. Our results in humans agree with published results from animal studies. We conclude that diabetes affects the heart via a quantifiable increase in chamber viscoelasticity (c) rather than an increase in chamber stiffness (k) and that phenotypic characterization of diabetic cardiomyopathy is facilitated by DF assessment via the PDF formalism.